The present disclosure concerns a surgical instrument for manipulating suture. In particular, the present disclosure relates to an instrument for passing suture through tissue.
In many surgical procedures, suture is used to close wounds and may be used to repair damage to ligaments and soft tissue. As part of the repair, suture may be routed through tissues to stitch or hold the tissue together, or for the purposes of capturing the tissue and anchoring it to a surgical implant such as a suture anchor. Known instruments for suture passing typically consist of a piercing portion or needle, which may be curved, and a means for retaining the suture within a portion of the needle to enable the suture to be manipulated and passed through tissue during the repair procedure.
In examples where the suture passing needle is hollow, potential problems may arise through tissue entrapment, where the most distal end of the needle opening may snag and tear tissue during use. In addition, the user may experience resistance to piercing as a result of the presence of the needle opening. Furthermore, and perhaps more problematic, having an opening at the distal end of the needle may weaken the instrument and result in bending of the needle tip and possibly instrument failure.
Alternative instruments include a suture passer and suture retriever slidably received within the needle lumen. For example, a suture passer may utilize a pre-memory formed flexible wire, in the form of a ribbon of nickel-titanium alloy, for capturing suture. However, operation of such instruments may require a high degree of accuracy when it is used to capture a suture. The flexible wire may be controlled through the instrument handle.
Further instruments may utilize a wire loop that extends from a distal needle and can be used to capture a suture which has been advanced by the suture passer, which exits the instrument from a second opening in the needle of the same device. The passer may have a modified distal end to readily advance and disengage a suture after it has been captured in the loop of the retriever. The passer and retriever may be manipulated longitudinally and rotationally with respect to the instrument so that the suture retriever can be passed through the needle pierced through tissue to be sutured. Retracting the instrument will cause one end of the suture to be pulled back through the tissue. When capturing and retrieving suture with this device, suture is fixed at the distal end of the device.
A problem associated with at least some of these instruments is that they do not allow a suture to slide within the device while the suture is contained within the instrument. Suture slide is an advantage for some other styles of suture passing devices. For those instruments which do not allow suture to slide, the method of maintaining the captured suture is by clamping down on it, this creates an increased risk of damaging the suture. In addition, tissue snagging and tearing during the passing of suture, due to the large profiles required by these more complex instruments are also problems.
A more convenient arthroscopic approach could have considerable advantages if these obstacles were overcome. In particular, the provision of a low profile instrument which allows a captured suture to slide within the instrument without snagging and results in reduced tissue damage is desirable. Accordingly, there exists a need for a better arthroscopic approach.